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They don’t understand!:
Helping students with emotional and mental
health disorders succeed in the classroom
Richard Van Acker, Ed.D.
University of Illinois at Chicago (M/C 147)
1040 W. Harrison
Chicago, Illinois 60607
(312) 996-2215
[email protected]
Mental Health Disorders
• Mental health problems cause major
changes in a person’s thinking, emotional
state, and behavior. Mental health
disorders disrupt a person’s ability to work
and to carry out their usual personal
relationships. These problems impede the
individuals ability to accurately perceive
and/or process information (sensory input,
language, etc.)
Functions of the Brain
impacted by mental health disorders
THINKING OR
COGNITION
BEHAVIOR
PERCEPTION OR
SENSING
PHYSICAL OR
SOMATIC
EMOTION OR
FEELINGS
SIGNALING (BEING RESPONSIVE
AND REACTING TO THE
ENVIRONMENT)
Mental Distress vs. Disorder
Distress
•
•
•
•
•
A response to environmental
challenges
May be adaptive
Usually short-term – does not
significantly impair functioning
Should not be ‘diagnosed’.
Usually does not require
professional intervention
Disorder
•
Onset not tied to environmental
challenges
•
Frequently long-term and impairs
functioning
Must meet recognized diagnostic
criteria
Frequently requires professional
intervention
Usually responds well to
evidence-based interventions
Usually helped by appropriate
supports and positive life-style
activities
•
•
•
•
Usually responds well to ‘typical’
support and positive life-style
activities
•
Seriousness of the Problem
Prevalence of Emotional Behavioral Disturbance (EBD)
Population Proportions
(9 to 17 year-olds)
5-9% Youth with EBD &
extreme functional
impairment
9-13% Youth with EBD,
with substantial
functional
impairment
5-9%
20%
9-13%
Youth with any
diagnosable
disorder
20%
Common Mental Health Concerns
Population as a Whole
Translation to the
‘average’ classroom
•
•
•
•
•
•
•
•
•
•
Depression – 6%
Psychosis – 1%
Anxiety Disorders – 10%
ADHD - 4%
Anorexia Nervosa – 0.2%
• Total - 15 – 20 %
Depression – 2 students
Psychosis – rare
Anxiety Disorders – 3 students
ADHD – 1 student
Anorexia Nervosa – rare
• Total – 4 – 5 students
Four Most Problematic Disorders
for School Personnel
• Reactive Attachment Disorder
• Bi-Polar Disorder
• Attention Deficit Hyperactivity Disorder
• Oppositional Defiant Behavior
Time of Initial Occurrence for
Common Behavior Problems
Learning Disorders
Emotional and Behavioral Disorders
Conduct Disorder
Oppositional Defiant Disorder
Attention Deficit-Hyperactivity Disorder
Compliance Problems
Language Disorders
Autism
Rett Syndrome
Asperger’s Syndrome
Reactive Attachment Disorder
Birth
6 years
Bi-Polar
Depression
12 years
Schizophrenia
Drug abuse
Bulimia
Anorexia nervosa
18 years
Wicks-Nelson & Israel, 2003
Time of Initial Occurrence for
Common Behavior Problems
Learning Disorders
Emotional and Behavioral Disorders
Conduct Disorder
Oppositional Defiant Disorder
Attention Deficit-Hyperactivity Disorder
Compliance Problems
Language Disorders
Autism
Rett Syndrome
Asperger’s Syndrome
Reactive Attachment Disorder
Birth
6 years
Bi-Polar
Depression
12 years
Schizophrenia
Drug abuse
Bulimia
Anorexia nervosa
18 years
Wicks-Nelson & Israel, 2003
Reactive Attachment Disorder
• Reactive attachment disorder (RAD) is a condition
found in children who have received grossly negligent
care and do not form a healthy emotional attachment
with their primary caregivers -- usually their mothers -before age 5.
• This can occur for many reasons, including:
– Persistent disregard of the child's emotional needs for
comfort, stimulation, and affection
– Persistent disregard of the child's basic physical needs
– Repeated changes of primary caregivers that prevent
formation of stable attachments (for example, frequent
changes in foster care)
There are two types of RAD: inhibited
and disinhibited.
• Common Symptoms of Inhibited RAD
Include:
–
–
–
–
Detached
Unresponsive or resistant to comforting
Excessively inhibited (holding back emotions)
Withdrawn or a mixture of approach and avoidance
• Common Symptoms With Disinhibited RAD
Include:
– Indiscriminate sociability
– Inappropriately familiar or selective in the choice of
attachment figures
Why IS Attachment Important?
• Attachment is essential for the formation of
a healthy personality which includes:
– Development of a conscience
– Ability to become self-reliant
– Ability to think logically
– Ability to cope with frustration and stress
– Ability to handle fear or threat to self
– Development of relationships
Symptoms Displayed by Individuals
with RAD
•
•
•
•
•
•
Lack of self-control / impulsive
Speech and language delays
Lack of conscience / shows no remorse
Indiscriminately affectionate with strangers
Avoids physical contact
Hyperactive
Symptoms (Cont.)
• Aggressive
• Destructive towards self, property, and
others
• Food issues: hordes, gorges, refuses to
eat, and/or hides food
• Often “on guard” – anxious, wary
• Prefers to play alone
• Inhibition or hesitancy in social situations
School Implications
• Children with RAD have difficulties selfregulating emotions and behaviors
• These children struggle to form typical,
reciprocal relationships with peers and
adults
• Self-regulatory and social skills are
important prerequisites for school
readiness and academic achievement
The Unique School Challenge for
Children with RAD
• While the school setting is meant to
educate, children with RAD are primarily
concerned with internal feelings of safety,
security, and trust
• Greater degree of dependency on the
teacher due to past disruptions in
attachment (learned helplessness, and
difficulty shifting between teachers)
How can Teachers Help
•
•
•
•
Be consistent, predictable, and repetitive
Set clear, concise expectations
Set and follow a classroom routine
Model and teach appropriate social
behaviors
• Maintain realistic expectations
• Ignore ‘junk behaviors’ – behaviors that
are not harmful to the child, others ot to
property
How Teachers Can Help (Cont.)
• Be patient with the child (and yourself)
• Understand behaviors – attempt to
promote and reinforce desired behaviors –
punishment per se is ineffective
• Help the child learn to regulate his/her
feelings and actions
• Utilize other resources for support (related
services providers, the internet, etc)
Bi-polar Disorder
• Bipolar disorder can be described as a
psychiatric diagnosis of mood disorders.
• The condition is defined by presence of 1
or more episodes that results from
elevated energy levels, cognition, and
mood imbalance such as depression
episodes.
Bipolar Disorder
• Symptoms of bipolar disorder include:
– mania,
– hypomania,
– depression,
– racing thoughts,
– sleep disturbances,
– delusional or grandiose thinking,
– hypersexuality and
– risky behavior with no regards for the
consequences.
Accommodations for Individuals
with BI-Polar Disorder (Lesley, 2009)
• Delivering praise and positive reinforcement
• Provide counseling to them or referring them to
counselors for assistances
• Offering peer assistance incentives and programs
• Decreasing distractions in school
• Provide frequent breaks when working
• Provide them with self-paced instruction, ‘chunked’
assignments, and flexible scheduling
• Provide clear, simple choices for desired behavior
• Keeping open channels of communication with them.
School Accommodations (Cont.)
• Provide Structured Classroom Settings – Students with Bipolar
Disorder need to be in classrooms with high structure and
predictability. This helps offset their cognitive and emotional
impairments. The educational atmosphere of organization allows
them to feel safe and accepted within their environments.
• Accommodations – For short attention span, high activity level,
organizational difficulties (e.g., frequent breaks; movement built into
the classroom schedule; use of fidgets, lap buddies, etc.; highly
structured routines; predictability; visual supports, such as visual
schedules, visual organizers for writing; use of computer technology,
software/keyboarding.
• Stress Management– Help the student to recognize internal states,
use stress reduction techniques.
• Problem Solving Skills – Focus on teaching effective strategies for
dealing with frustration and negative thinking. Help them develop a
plan such as establishing a "cool down" or safe place to go when
feeling upset
Attention Deficit Hyperactivity
Disorder
• ADHD is a disorder characterized by the
symptoms of hyperactivity, inattention,
and/or impulsivity that are more frequent
and severe than is typically seen in one's
peers
ADHD - Inattentive Symptoms
• Fails to give close attention to details or makes careless
mistakes in schoolwork
• Has difficulty keeping attention during tasks or play
• Does not seem to listen when spoken to directly
• Does not follow through on instructions and fails to finish
schoolwork or chores and tasks
• Has problems organizing tasks and activities
• Avoids or dislikes tasks that require sustained mental
effort (such as schoolwork)
• Often loses toys, assignments, pencils, books, or tools
needed for tasks or activities
• Is easily distracted
• Is often forgetful in daily activities
ADHD - Hyperactivity Symptoms
•
•
•
•
•
Fidgets with hands or feet or squirms in seat
Leaves seat when remaining seated is expected
Runs about or climbs in inappropriate situations
Has problems playing or working quietly
Is often "on the go," acts as if "driven by a
motor"
• Talks excessively
ADHD- Impulsivity Symptoms
• Blurts out answers before questions have
been completed
• Has difficulty awaiting turn
• Interrupts or intrudes on others (butts into
conversations or games)
ADHD and the Brain
• Cortex of the brain is
significantly thinner in
people with ADHD –
especially in the frontal
lobe areas of the brain.
– Less risk inhibition
– Poor attention
• Immaturity in specific brain
structures in the limbic
system - the inhibitory
system regulating arousal
and reward.
Accommodations for ADHD
•
Helping children with ADD/ADHD follow directions means taking measures to break
down and reinforce the steps involved in your instructions, and redirecting when
necessary.
•
Seat the child with ADD/ADHD away from doors and windows. Put pets in another
room or a corner while the student is working.
•
Alternate seated activities with those that allow the child to move his or her body
around the room. Whenever possible, incorporate physical movement into lessons.
•
Write important information down where the child can easily read and reference it.
Remind the student where the information can be found.
•
Divide big assignments into smaller ones, and allow children frequent breaks.
•
Reducing the interruptions of children with ADD/ADHD should be done carefully so
that the child’s self-esteem is maintained, especially in front of others. Develop a
“secret language” with the child with ADD/ADHD. You can use discreet gestures or
words you have previously agreed upon to let the child know they are interrupting.
In children with Oppositional
Defiant Disorder (ODD),
• …there is an ongoing pattern of uncooperative, defiant, and hostile
behavior toward authority figures that seriously interferes with the
youngster’s day to day functioning. Symptoms of ODD may include:
–
–
–
–
–
–
–
–
–
–
Frequent temper tantrums
Excessive arguing with adults
Often questioning rules
Active defiance and refusal to comply with adult requests and
rules
Deliberate attempts to annoy or upset people
Blaming others for his or her mistakes or misbehavior
Often being touchy or easily annoyed by others
Frequent anger and resentment
Mean and hateful talking when upset
Spiteful attitude and revenge seeking
ODD and the Brain
• The development of oppositional defiant disorder is
associated with changes in the neurotransmitters of the
brain.
• Neurotransmitters are chemical transmitters of impulses
between nerve cells.
• Raising or lowering the level of neurotransmitters (i.e.,
deviation from the norm) leads to a sudden change in mood
and changes in the thinking process because of impaired
transmission of nerve impulses.
• That’s why people with ODD have:
– a sense of irritation,
– they have no fear of punishment,
– they often cannot adequately perceive the reality and communicate
normally,
External Factors Impacting the
Development of ODD
• The major familial external factors that contribute
to the development of ODD disorder:
–
–
–
–
domestic violence,
abuse (physical or sexual abuse),
indifference of parents,
disastrous financial situation (poverty), or poor quality
of life,
– drug and alcohol use by parents.
• The major school-based external factors include:
– excessive punishment or punishment for behavior
outside the control of the student,
– abuse by adults and peers, and/or
– Indifference on the part of teachers
Treatment
• Typically multimodal treatment involving:
– Medication – (e.g., anti-depressants, mood
elevators, anti-anxiety medications, stimulant
medications).
– Behavioral Interventions – clear expectations
and predictable contingencies designed to
reduce problem behaviors and to facilitate
student success.
– Cognitive Behavioral Interventions – (e.g.,
self-regulation, attributional retraining,
cognitive restructuring)
World Health Organization
Model for School Mental Health Promotion
3-12%
20-30%
All Teachers
and Students
The Entire
School
Community
Professional
Treatment
Psycho- Social
Interventions
Students needing
Additional Mental
Health Treatment
Students needing
Additional Help
Mental Health Education –
Knowledge, Attitudes and Behavior
Positive and Supportive School Climate
Realistic expectations for all students
Academic and social emotional support
Part of General
Curriculum
Whole School
Environment
Failure of school personnel to
understand the complex nature
of behavior
Disability
Habit
Needs and
Desires
Culture
The Functional Assessment of
Behavior
• The identification of the target behavior
• An informed hypothesis as to function of the behavior
• Data collection
– Indirect data collection
– Direct data collection
• Verification – Triangulation of data
– Functional analysis of behavior
• Developing the behavior intervention plan
– Program to decrease undesired behavior
– Program to increase desired alternative behavior
• Monitoring the implementation and evaluation
Behavior Problems can Occur
for many different reasons:
•
•
•
•
•
•
Attention
Escape
Tangible reward
Peer Affiliation
Justice or Revenge
To communicate intent - if
language impaired
• Knowledge deficits
– Does not know what is
expected
• Not enough practice of skill
– Has not learned to
generalize skill
– Indicate physical discomfort
– Indicate frustration or need for help
• Sensory/Perceptual Needs
– Stereotypic or self-injurious
– Sensory input needs
(Modified from: Neal & Cessna, 1993)
Maslow’s Hierarchy of Needs
SelfActualization
Self-Esteem
Achievement
Belonging / Love
Safety
Physiological Needs
(Food, water, clothing for warmth, touch)
Careful Observation to Identify
Triggers
• Often as one of the people who spends the most
time directly interacting with a student, you may
quickly become aware of when a student moves
away from his or her typical or ‘baseline’
behavior.
• This may be signaled by an increase or a
decrease in behavior.
• A critical skill in working with children like Robbie
is to be good at observing triggers that may
serve to move a student into a potential crisis
situation.
Understanding the Crisis
Crisis
Escalation
De-escalation
Agitation
Trigger
Hangover/Recovery
Adapted from: Managing the Cycle of
Acting-Out Behavior in the Classroom
By Dr. Geoff Colvin
Understanding the Crisis
Crisis
De-escalation
Escalation
Agitation
Trigger
Hangover
Student Cognition
Understanding the Crisis
Crisis
De-escalation
Escalation
Staff Movement
Agitation
Away from Self Control
Trigger
Hangover
Student Cognition
Understanding the Crisis
Crisis
De-escalation
Escalation
Staff Movement
Agitation
Away from Self Control
Trigger
Staff Cognition
Student Cognition
Hangover
Understanding the Crisis
Crisis
De-escalation
Escalation
Agitation
Trigger
Area of Greatest
Influence
Hangover
Let’s Think About a Student
• Randy is a freshman
•Randy and his family have recently
moved into the school district from
another urban school district (Dade
County Florida – Miami).
•Randy is a very reluctant learner.
•At times, Randy can become
disruptive to the classroom setting.
•Randy seldom completes the
assigned work and almost never does
homework
•
•
•
•
•
•
•
•
•
•
•
•
•
•
The classroom teacher has assigned the class to read the next 6 pages in
the Social Studies text and to answer the questions at the end of the
chapter.
Randy starts to try and do the lesson. He begins to look upset. He is
displaying increased movement and he is starting to look around the room
and to divert his attention from the task. He mumbles to himself and starts
to actively protest that, ”This shit is stupid. Nobody cares about this crap.”
The teacher moves towards Randy and asks if everything is okay?
Randy says, “I don’t know why we can’t do this as a class or with partners.
This is really boring!”
The teacher says, “I know you can do this if you try – just do your best”
Randy says, “I hate this shit!”
The teacher says. “Randy you need to watch your language. You can not
cuss in this classroom.”
Randy says, “Don’t tell me what I can and can not do. You aren’t my boss!”
The teacher says, “Randy, we have to all get along and do what is asked of
us – otherwise the classroom just won’t work.”
In a loud voice, Randy says, “I’m tired of this bullshit. I hate this f___king
class.” Randy starts to get up to exit the classroom.
The teacher steps in his way (to block his exit) and says, “Sit down right
now and do what I have asked you to do! Stop swearing!”
Randy says, “F__k you! I am out of here!”
The teacher moves towards Randy and grabs his arm – attempting to move
him back to his seat.
Randy shakes her hand off of his arm and pushes past her – exiting the
classroom.
Additional Information
• Randy is a student with both learning and
emotional disorders (Anxiety Disorders).
• He can become overwhelmed very easily and
often becomes frustrated and will either simply
‘shut down’ or he will become argumentative
(loud protests and threats to hurt others or to
leave the instructional area).
• The text is written at the 9.4 grade level. Randy
has 4.3 grade level decoding skills and even
lower levels of reading comprehension.
Debriefing
Student
Behavior
Staff Behavior
Escalate
Neutral
Reduce
Options
Debriefing
Student
Behavior
Staff Behavior
Teacher assigns 6
pages to read
Escalate
Neutral
Reduce
Options
Debriefing
Student
Behavior
Staff Behavior
Teacher assigns 6
pages to read
Starts to look
agitated – This shit’s
stupid
Escalate
Neutral
Reduce
Options
Debriefing
Student
Behavior
Staff Behavior
Teacher assigns 6
pages to read
Starts to look
agitated – This shit’s
stupid
Is everything ok?
Escalate
Neutral
Reduce
Options
Debriefing
Student
Behavior
Staff Behavior
Teacher assigns 6
pages to read
Starts to look
agitated – This shit’s
stupid
Is everything ok?
Escalate
Neutral
Reduce
Options
Debriefing
Student
Behavior
Staff Behavior
Teacher assigns 6
pages to read
Starts to look
agitated – This shit’s
stupid
Why not do this as a
class, partners – This
stuff is boring.
Is everything ok?
Escalate
Neutral
Reduce
Options
Debriefing
Student
Behavior
Staff Behavior
Teacher assigns 6
pages to read
Starts to look
agitated – This shit’s
stupid
Is everything ok?
Why not do this as a
class, partners – This
stuff is boring.
Try – Do your best
Escalate
Neutral
Reduce
Options
Debriefing
Student
Behavior
Staff Behavior
Teacher assigns 6
pages to read
Starts to look
agitated – This shit’s
stupid
Is everything ok?
Why not do this as a
class, partners – This
stuff is boring.
Try – Do your best
Escalate
Neutral
Reduce
Options
Debriefing
Student
Behavior
Staff Behavior
Teacher assigns 6
pages to read
Starts to look
agitated – This shit’s
stupid
Is everything ok?
Why not do this as a
class, partners – This
stuff is boring.
Try – Do your best
I hate this shit.
Escalate
Neutral
Reduce
Options
Debriefing
Student
Behavior
Staff Behavior
Teacher assigns 6
pages to read
Starts to look
agitated – This shit’s
stupid
Is everything ok?
Why not do this as a
class, partners – This
stuff is boring.
Try – Do your best
I hate this shit.
Watch your language
– can’t cuss
Escalate
Neutral
Reduce
Options
Debriefing
Student
Behavior
Staff Behavior
Teacher assigns 6
pages to read
Starts to look
agitated – This shit’s
stupid
Is everything ok?
Why not do this as a
class, partners – This
stuff is boring.
Try – Do your best
I hate this shit.
Watch your language
– can’t cuss
Escalate
Neutral
Reduce
Options
Debriefing
Student
Behavior
Staff Behavior
Teacher assigns 6
pages to read
Starts to look
agitated – This shit’s
stupid
Is everything ok?
Why not do this as a
class, partners – This
stuff is boring.
Try – Do your best
I hate this shit.
Watch your language
– can’t cuss
Don’t tell me what to
do – you are not my
boss
Escalate
Neutral
Reduce
Options
Debriefing
Student
Behavior
Staff Behavior
Teacher assigns 6
pages to read
Starts to look
agitated – This shit’s
stupid
Is everything ok?
Why not do this as a
class, partners – This
stuff is boring.
Try – Do your best
I hate this shit.
Watch your language
– can’t cuss
Don’t tell me what to
do – you are not my
boss
We have to get along
or school won’t work
Escalate
Neutral
Reduce
Options
Debriefing
Student
Behavior
Staff Behavior
Teacher assigns 6
pages to read
Starts to look
agitated – This shit’s
stupid
Is everything ok?
Why not do this as a
class, partners – This
stuff is boring.
Try – Do your best
I hate this shit.
Watch your language
– can’t cuss
Don’t tell me what to
do – you are not my
boss
We have to get along
or school won’t work
Escalate
Neutral
Reduce
Options
Debriefing
Student
Behavior
Staff Behavior
Teacher assigns 6
pages to read
Starts to look
agitated – This shit’s
stupid
Is everything ok?
Why not do this as a
class, partners – This
stuff is boring.
Try – Do your best
I hate this shit.
Watch your language
– can’t cuss
Don’t tell me what to
do – you are not my
boss
We have to get along
or school won’t work
Tired of this bullsh_t,
I hate this f_cking
class
Escalate
Neutral
Reduce
Options
Debriefing
Student
Behavior
Staff Behavior
Teacher assigns 6
pages to read
Starts to look
agitated – This shit’s
stupid
Is everything ok?
Why not do this as a
class, partners – This
stuff is boring.
Try – Do your best
I hate this shit.
Watch your language
– can’t cuss
Don’t tell me what to
do – you are not my
boss
We have to get along
or school won’t work
Tired of this bullsh_t,
I hate this f_cking
class
Stop swearing – Sit
down right now –
Blocks exit
Escalate
Neutral
Reduce
Options
Debriefing
Student
Behavior
Staff Behavior
Teacher assigns 6
pages to read
Starts to look
agitated – This shit’s
stupid
Is everything ok?
Why not do this as a
class, partners – This
stuff is boring.
Try – Do your best
I hate this shit.
Watch your language
– can’t cuss
Don’t tell me what to
do – you are not my
boss
We have to get along
or school won’t work
Tired of this bullsh_t,
I hate this f_cking
class
Stop swearing – Sit
down right now –
Blocks exit
Escalate
Neutral
Reduce
Options
Debriefing
Student
Behavior
Staff Behavior
Teacher assigns 6
pages to read
Starts to look
agitated – This shit’s
stupid
Is everything ok?
Why not do this as a
class, partners – This
stuff is boring.
Try – Do your best
I hate this shit.
Watch your language
– can’t cuss
Don’t tell me what to
do – you are not my
boss
We have to get along
or school won’t work
Tired of this bullsh_t,
I hate this f_cking
class
Stop swearing – Sit
down right now –
Blocks exit
F_ck you! I am out of
here – starts to exit
Escalate
Neutral
Reduce
Options
Debriefing
Student
Behavior
Staff Behavior
Teacher assigns 6
pages to read
Starts to look
agitated – This shit’s
stupid
Is everything ok?
Why not do this as a
class, partners – This
stuff is boring.
Try – Do your best
I hate this shit.
Watch your language
– can’t cuss
Don’t tell me what to
do – you are not my
boss
We have to get along
or school won’t work
Tired of this bullsh_t,
I hate this f_cking
class
Stop swearing – Sit
down right now –
Blocks exit
F_ck you! I am out of
here – starts to exit
Teacher grabs his
arm and attempts to
guide him to seat
Escalate
Neutral
Reduce
Options
Debriefing
Student
Behavior
Staff Behavior
Teacher assigns 6
pages to read
Starts to look
agitated – This shit’s
stupid
Is everything ok?
Why not do this as a
class, partners – This
stuff is boring.
Try – Do your best
I hate this shit.
Watch your language
– can’t cuss
Don’t tell me what to
do – you are not my
boss
We have to get along
or school won’t work
Tired of this bullsh_t,
I hate this f_cking
class
Stop swearing – Sit
down right now –
Blocks exit
F_ck you! I am out of
here – starts to exit
Teacher grabs his
arm and attempts to
guide him to seat
Escalate
Neutral
Reduce
Options
Debriefing
Student
Behavior
Staff Behavior
Teacher assigns 6
pages to read
Starts to look
agitated – This shit’s
stupid
Is everything ok?
Why not do this as a
class, partners – This
stuff is boring.
Try – Do your best
I hate this shit.
Watch your language
– can’t cuss
Don’t tell me what to
do – you are not my
boss
We have to get along
or school won’t work
Tired of this bullsh_t,
I hate this f_cking
class
Stop swearing – Sit
down right now –
Blocks exit
F_ck you! I am out of
here – starts to exit
Teacher grabs his
arm and attempts to
guide him to seat
Shakes her arm off He pushes past
teacher - exits
Escalate
Neutral
Reduce
Options
Understanding the Crisis
Teacher grabs his arm
Teacher blocks escape
Crisis
De-escalation
Need to do what is asked
Watch your language
You can do it if you try
Reading Level
Escalation
Agitation
Trigger
Hangover
Looking for a ‘Win-Win”
Crisis
De-escalation
Escalation
Agitation
Trigger
What would have been some options to help
engage Jason in study of cell structure?
1.
2.
3.
Hangover
Does anyone speed when you
drive?
• Are there places you
don’t tend to speed?
• Generally has more to
do with the likelihood
of being caught than
the nature of the fine.
Simple Consequence to
Reduce High Rate Behaviors
Library Envelope System
• Make one library pocket card for each
student
Number of cards
Aaron
Lashika
Randy
Sarah
Anita
Lashonda
Joe
based on
baseline data –
student need.
Mary
Scott
Free ticket
2-3 minute delay Detention loss
to recess or
of recess
passing
Selecting Consequences
• Should develop, maintain, or
maximize the relationship between
the student and teacher.
• Should allow student to learn an
alternative pro-social behavior.
• Should allow student to practice
the alternative behavior.
• Should be rather quick and simple
to apply.
• Should minimize student resistance.
Cognitive Behavioral Intervention
• CBI focuses on two general areas:
– Cognitions – target the student’s private
speech about himself, the environment, and
his future. Explores beliefs and attitudes.
– Behaviors – targets specific behaviors that
tend to reinforce or trigger maladaptive,
dysfunctional or irrational thoughts, beliefs
and attitudes.
Cognitions
Behaviors
Strives to have the student intervene on his or her own behavior.
Self-Regulation/Self-Control
• Self-monitoring – the ability to collect data
or otherwise identify one’s own thoughts
and behavior.
• Self-evaluation – to be able to judge one’s
performance accurately against some
standard of performance.
• Self-reinforcement – the ability to deliver
self-praise or a reward contingently on the
display of a specified desired behavior.
Commonly used materials and resources
Cognitive techniques
• Emotion thermometer 10
Really scared or upset
9
Ask for help.
8
7
Pretty scared or upset
Take a break.
6
5
4
A little bit scared or upset
Not at all scared or upset
3
2
Count to 10
slowly.
1
Take a few deep
breaths.
0
Self-praise
Student Recommended for CICO
CICO Implemented
CICO Coordinator
Summarizes Data
For Decision Making
Morning
Check-in
Parent
Feedback
Regular Teacher
Feedback
Bi-weekly Meeting
to Assess Student
Progress
Afternoon
Check-out
Revise
Program
Graduate
Program
Student: ___________________ Teacher: ________________ Date:________
Subject Area
Behavior
Scoring Rubric
Soc
Stud
Math
Science
Reading
Uses Kind words and
actions
Displays kind and welcoming behavior towards others
Teases, taunts or displays rude or disrespectful behavior
towards others
Threatens harm or displays verbal/physical aggression
towards others
4
1
0
4
1
0
4
1
0
4
1
0
4
1
0
4
1
0
4
1
0
Active Task Engagement
On-task more than 85% of the interval
On task more than 50% but less than 85% of the interval
On-task more than 10% but less than 50% of the interval
On-task less than 10% of the interval
3
2
1
0
3
2
1
0
3
2
1
0
3
2
1
0
3
2
1
0
3
2
1
0
3
2
1
0
Follows Teacher Directives
Spontaneously complies to at least 90% of teacher
directives
Verbally protests but complies to at least 90% of directives
Fails to comply to at least 25% of directives but does not
engage in problem behavior
Fails to comply to at least 25% of directives and engages in
problem behavior
4
2
1
0
4
2
1
0
4
2
1
0
4
2
1
0
4
2
1
0
4
2
1
0
4
2
1
0
Stays in the Assigned Area
Exits the classroom without permission (any time during
interval)
Out of seat or assigned area and fails to comply with initial
request to return
Remains in the seat or assigned area throughout the
interval
Out of seat or instructional area but returns the first time
asked
4
2
1
0
4
2
1
0
4
2
1
0
4
2
1
0
4
2
1
0
4
2
1
0
4
2
1
0
Work Completion
Work completed with reasonable level of effort (Not
concerned with accuracy or neatness at this time)
Effort expended at a reasonable level but work not
completed
Little or no work attempted
4
2
0
4
2
0
4
2
0
4
2
0
4
2
0
4
2
0
4
2
0
Comments:
Self-Instruction Training
(Meichenbaum & Goodman 1971)
• Cognitive Modeling – the teacher performs a task
•
•
•
•
while talking aloud; the student observes.
Overt External Guidance – The student and teacher
both perform the task while talking aloud together.
Overt Self-Guidance – The student performs the task
using the same verbalizations as the teacher (talk
together).
Faded Self-Guidance – The student whispers the
instructions (often in an abbreviated form) while going
through the task.
Covert Self-Guidance – The student performs the
task, guided by self-speech.
Five Common Irrational
/Dysfunctional Thoughts
• Arbitrary Inference – the drawing of a conclusion
when evidence is lacking or actually supports a
contrary conclusion.
• Magnification – exaggeration of the meaning of
an event.
• Cognitive deficiency – disregard for an important
aspect of a life situation.
• Dichotomous Reasoning – overly simplified and
rigid perception of events as good or bad, right
or wrong.
• Overgeneralization – taking a single incident
such as a failure as a sign of total incompetence
and in this way generalizing a fallacious rule.
Ethical Dilemma of Teaching
in Today’s Classroom
• The rise in the demand for greater
accountability for student academic
excellence has increased the anxiety level
of both teachers and students.
• Increase in the display of mental health
symptoms within the school setting.
– Increased levels of frustration and fear.
– Increased levels of student failure.
Schools as Mental Health Service
Providers
Service Provider
Arrangement
School
Relationship
Provider Type
Services
Barriers
Special Education
Hired by school or
school district
School
Psychologists
Special Education
Testing, IDEA
implementation
Time spent on testing, not
accessible to all students
Stand Alone School
Program
School or school
district hires
providers or
program
Social Workers,
child psychologists,
teachers
Counseling,
Interventions for
specific mental
health issues
Stigma, Time, Program
cost
Community Linked
School or school
district contracts
with organization
for the provision of
services
Social Workers,
child psychologists,
psychiatrist, crisis
counselors
Varied – crisis/ as
needed to
comprehensive
mental health
services
Not linked to other school
services, providing as
needed does not address
issue of lack of services
Other Service
Provider Options
May occur on
school premises but
not during school
hours
Varied
Varied
Not always linked to
school services, may not
reach all needy children
School Based Health
Centers
Located at or near
schools
Varied
Varied
Funding and space
Mental Health Problems are Real!
• They impact the student’s ability to
process information and to make
rational decisions when disorder is
displayed.
• Most teachers have no problem
understanding that the nature of the
demands they place on a student
change when he is physically ill
(e.g., having just thrown up or
displaying a high fever).
• These same teachers often do not
understand the need to address the
student in a different manner when
their mental health disorder is
impacting the student’s behavior.
Embedding Cognitive Behavioral Strategies
Across the School Day
Common Practices
Common Opportunities
Examples
Direct instruction of
cognitive behavioral
strategy along with an
academic lesson
(Double Dipping)
•Language Arts
•History/Social Science
•Physical Education
Bibliotherapy –
selecting a book with a
key social theme to
teach language arts
and social problem
solving
Provide students with
opportunities to practice
strategies by carefully
sabotaging an
instructional or social
situation.
•Physical Education
•Recess
•Science
•Keyboarding/Computer
Lab
•Art Class
Selecting teams that
must share limited
materials.
Incidental teaching
•Recess/Lunch
•Free time/ Transitions
Solving social
problems on the
playground.
Placing students in
very close proximity to
one another.
Mental Health Problem
•Aggression
•Poor self control
•Impulsivity
Sample Components of CBI
•Guiding self statements
("Stop, Think Act")
•Positive self statements
("You can solve this
problem")
•Verbal self-instructions
("What are all of my options
to solve this problem?")
•Relaxation training
(controlled breathing,
progressive muscle
relaxation)
•Reinforcement for using
skills
Mental Health Problem
•Nighttime fears
•School refusal
•Separation anxiety
•Generalized anxiety
•Specific phobias
•Social phobia
•Obsessive Compulsive
Disorder
Sample Components of CBI
•Recognition of faulty
cognitions ("I can't go in that
elevator"; "Everyone will laugh
at me when I give my talk")
•Positive self statements ("I
can handle this"; "I know that's
just my anxiety telling me lies")
•Relaxation training
•Modeling, role playing,
reinforcement for using CBT
skills
•Exposure to a hierarchy of
anxiety-producing situations
Linking Literature to Social Skill
Development in Students with
Behavioral Challenges
Bonnie McCarty & Gyneth Slygh (2004)
•
•
•
•
Rationale for using bibliotherapy
System to analyze literature for use with students
Annotated bibliographies
Sample lesson plans
http://dpi.wi.gov/sped/doc/ebdlitsosk.doc-418.5KB
Information Source
• The Wisconsin Department of Public Instruction has
developed:
A Look at the Mental Health Needs of Children in an
Educational Setting
This resource lists the risk factors, symptoms, and
possible school intervention strategies for a number of
mental health disorders in children and youth. Including:
–
–
–
–
–
–
–
–
Anxiety Disorders
Bipolar Disorder
Borderline Personality Disorder
Depression
Obsessive Compulsive Disorder
Oppositional Defiant Disorder
Post Traumatic Stress Disorder, and
Schizophrenia
www.dpi.wi.gov/sped/doc/ebdmhfacts.doc
Questions?
For More Information
• The Center for Health and Health Care in Schools
www.healthinschools.org
• Center for Mental Health Services
http://www.mentalhealth.org/cmhs/
• Mental Health: The Surgeon General's Report
http://www.surgeongeneral.gov/library/mentalhealth/toc.html#chapte
r3
• National Institute of Mental Health
http://www.nimh.nih.gov
• University of Maryland Center for School Mental Health
Assistance
http://csmha.umaryland.edu/
• School Mental Health Project
http://smhp.psych.ucla.edu